Beyond Trauma A Presentation of Dr. Stephanie Covington’s Trauma Theory and Beyond Trauma Women’s Groups

Stephanie Covington

Developed gender specific trauma responsive curriculum

Developed curriculum and activities for women who are incarcerated

Developed activities related to substance use and trauma informed framework

www.centerforgenderandjustice.org

www.stephaniecovington.com

Crisis = Danger + Opportunity Levels of Violence Childhood

Adolescence

Adult

Street

Consumer Culture

Media

War

Planet

“The death and disability caused by violence make it one of the leading public health issues of our time” - World Health Organization

Thinking About Trauma

Two Kinds of Suffering

Natural

Created

Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources

Traumatic Events Trauma can take many forms:

Emotional, sexual, or physical abuse

Neglect

Abandonment (especially for small children)

Extremely painful and frightening medical procedures

Catastrophic injuries and illnesses

Rape or assault

Traumatic Events

Trauma can take many forms:

Muggings

Domestic Violence

Burglary

Automobile accidents

Immigration

Natural disasters (hurricanes, floods, earthquakes, tornadoes, fires, volcanoes)

Traumatic Events

Trauma can take many forms:

Terrorism such as September 11, 2001

Witnessing violence

Loss of a loved one and severe bereavements

Torture

Kidnapping

Intergenerational (cultural) trauma

Historical Trauma

Across generations

Massive group trauma

Examples include: Genocide and cultural erasure of indigenous people of North America, Slavery of African peoples, Holocaust survivors, Japanese internment survivors

Interpersonal Violence Intimate Partner Violence (IPV)

Of all these forms of trauma, women are at greater risk of interpersonal abuse than men

Traumatic Experiences

Oppression

Racism

Sexism

Homophobia/Biphobia/Transphobia

Ableism

Etc.

Process of Trauma TRAUMATIC EVENT

Overwhelms the Physical & Psychological systems, Intense Fear, Helplessness, or Horror

RESPONSE TO TRAUMA Fight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing,

Hyper-vigilance, Hyper-arousal

SENSITIZED NERVOUS SYSTEM CHANGES IN THE BRAIN

CURRENT STRESS Reminders of Trauma, Life Events, Lifestyle

PAINFUL EMOTIONAL STATE

RETREAT

ISOLATION DISSOCIATION DEPRESSION

ANXIETY

HARM TO SELF

SUBSTANCE ABUSE EATING DISORDER

DELIBERATE SELF-HARM SUICIDAL ACTIONS

HARM TO OTHERS

AGGRESSION VIOLENCE

RAGES

Trauma-Informed Services

Take the trauma into account

Avoid triggering trauma reactions

Adjust organization so that trauma survivors can access and benefit from services

(Harris & Fallot)

Core Principles of Trauma-Informed Care

Safety (physical and emotional)

Trustworthiness

Choice

Collaboration

Empowerment (Harris & Fallot)

A Culture Shift: Core Values of a Trauma-Informed System of Care

Safety: Ensuring physical and emotional safety

Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries

Choice: Prioritizing consumer choice and control

Collaboration: Maximizing collaboration and sharing of power with consumers

Empowerment: Prioritizing consumer empowerment and skill-building

A Culture Shift: Scope of Change in a Distressed System

Involves all aspects of program activities, setting, relationships, and atmosphere (more than implementing new services)

Involves all groups: administrators, supervisors, direct service staff, support staff, and consumers (more than service providers)

Involves making trauma-informed change into a new routine, a new way of thinking and acting (more than new information)

A Culture Shift: Changes in Understanding & Practice

Thinking differently as a prelude to acting differently

Thinking differently initiates and sustains changes in practice and setting

Acting differently reinforces and clarifies changes in understanding

The Adverse Childhood Experiences (ACE) Study

Collaboration between

Centers for Disease Control and Prevention (CDC)

Kaiser Permanente HMO in California

Largest study ever

17,000 adult members participated

Population studied

80% white

74% college graduates (36% some college)

18% high school graduates

The Adverse Childhood Experiences (ACE) Study

Before age 18:

Recurrent and severe emotional abuse

Recurrent and severe physical abuse

Contact sexual abuse

Physical neglect

Emotional neglect

The Adverse Childhood Experiences (ACE) Study

Growing up in a household with:

An alcoholic or drug-user

A member being imprisoned

A mentally ill, chronically depressed, or institutionalized member

The mother being treated violently

Both biological parents not being present

The Adverse Childhood Experiences (ACE) Study RESULTS

ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.

Smoking

Alcoholism

Injection of illegal drugs

Obesity

Higher ACE Score Chronic Health Conditions

Heart disease

Autoimmune diseases

Lung cancer

Pulmonary disease

Liver disease

Skeletal fractures

Sexually transmitted infections

HIV/AIDS

The Adverse Childhood Experiences (ACE) Study

Men 16% Sexual Abuse

Women 27% Sexual Abuse

Men 27% Physical Abuse

The Adverse Childhood Experiences (ACE) Study

Women 50% more likely than men to have a score of 5 or more

Adverse Childhood Experiences www.ACEStooHigh.com www.cdc.gov/ace

ACE Study Walla Walla, WA (www.ACEStooHigh.com)

Wow. Are you okay?

What’s going on?

1 – 10 with anger

ACE Study Walla Walla, WA (www.ACEStooHigh.com)

2009 – 2010 (Before new approach)

798 suspensions

50 expulsions

600 written referrals

2010 – 2011 (After new approach)

135 suspensions

30 expulsions

320 written referrals

Critical and Interrelated Issues Substance Abuse

Mental Health

Trauma

Physical Health

Crime

Changes in Understanding: The Centrality of Trauma

Violence &

Trauma

Incarceration

Homelessness

Mental Health Problems

Substance Abuse

Areas of Separation

Training

Treatment

Categorical Funding

Level of Burden

“Burden” defined as the total number of problem conditions

Use of alcohol and/or other drugs

Homelessness

Significant health disorder

HIV/AIDS

Cognitive impairment

History of childhood or adult abuse

Changes in Understanding: Why Trauma-Informed Services?

Trauma is pervasive

Trauma’s impact is broad and diverse

Trauma’s impact is deep and life-shaping

Trauma, especially interpersonal violence, is often self-perpetuating

Trauma differentially affects the more vulnerable

The service system has often been retraumatizing

Staff members are deeply affected by systemic stressors

Theory Framework for Beyond Trauma Groups

Definition of Recovery

The definition of recovery has shifted from a focus on what is deleted from one’s life (alcohol and other drugs, arrests for criminal acts, hospitalizations) to what is added to one’s life (the achievement of health and happiness).

Prevalence of Trauma and PTSD in Substance Use/Abuse

60% to 90% of a treatment-seeking sample of substance abusers also have a history of victimization

More than 80% of women seeking treatment for a substance use disorder reported experiencing physical/sexual abuse during their lifetime

Prevalence of Trauma and PTSD in Substance Use/Abuse

Between 44% and 56% of women seeking treatment for a substance use disorder had a lifetime history of PTSD

10.3% of the men and 26.2% of the women with a lifetime diagnosis of alcohol dependence also had a history of PTSD

Histories of Trauma/Violence Among Clients Treated for Methamphetamine

Persons in treatment for methamphetamine report high rates of trauma

85% women

69% men

Histories of Trauma/Violence Among Clients Treated for Methamphetamine

Most common source of trauma/violence:

For women, was a partner (80%)

For men, was a stranger (43%)

History of sexual abuse

57% women

16% men

Prevalence of Trauma and PTSD in Severe Mental Illness

98% reported exposure to at least one traumatic event, lifetime

43% of sample received a current diagnosis of PTSD; only 2% had PTSD diagnosis in their charts

Severely mentally ill patients who were exposed to traumatic events tended to have been multiply traumatized, with exposure to an average of 3.5 different types of trauma

Gender and Abuse

As children, boys and girls suffer similar rates of abuse

Girls – sexually abused

Boys – emotional neglect and physical abuse

Gender and Abuse

In adolescence, boys are at greater risk if they are gay, young men of color, or gang members

Young men – people who dislike or hate them

Young women – relationships; from the person to whom she is saying “I love you”

Gender and Abuse

Adulthood

Man – combat or being a victim of a crime

Woman - relationships; from the person to whom she is saying “I love you”

Sexual Assault Graph

Bureau of Justice Statistics

Sexual Assault Graph

Bureau of Justice Statistics

Gender Responsive Treatment

Creating an environment through

Site selection

Staff selection

Program development

Content and material

that reflects an understanding of the realities of women and girls, and

addresses and responds to their strengths and challenges

Women’s Integrated Treatment

This model is holistic, integrated, and based on:

The gender responsive definition and guiding principles

A theoretical foundation

Interventions/strategies that are multi-dimensional

Theoretical Foundation

The theories related to gender and substance abuse (and any other relevant treatment services) that create the framework of thought for program development.

This is the knowledge base that creates the foundation upon which the program is developed.

Treatment Strategies

The approaches used in the program that create the therapeutic process.

These are the ways in which the theory is operationalized (how theory is applied).

Module A – Violence, Abuse, and Trauma

Session 1: The Connections between Violence, Abuse, and Trauma

Session 2: Power and Abuse

Module A – Violence, Abuse, and Trauma OVERVIEW

Defining trauma and developing an understanding of trauma and trauma responses

Thinking about gender roles/expectations

Understanding the connection between power and abuse in society

Module A – Violence, Abuse, and Trauma ACTIVITY

Module B – video and collage

Module C – Healing from Trauma

Session 5: The Addiction and Trauma Connection: Spirals of Recovery and Healing

Session 6: Grounding and Self-Soothing

Session 7: Abuse and the Family

Module C – Healing from Trauma

Session 8: Mind and Body Connection

Session 9: The World of Feelings

Session 10: Healthy Relationships: Wheel of Love

Session 11: Endings and Beginnings

Module C – Healing from Trauma OVERVIEW

Learning about addiction/trauma connection

Self-care, physical and emotional safety

Learn grounding and self-soothing techniques

Understand dynamics and impact of abuse in families

Understand connection between mind and body

Experience feelings

Learn elements of healthy relationships

Module C – Healing from Trauma

Next steps discussion

THANK YOU!

Liz Cascone, Advocacy Manager, lcascone@vsdvalliance.org Quillin Drew Musgrave, Member Support Manager, qdrew@vsdvalliance.org